Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients Rupley DM, Janda AM, Kapeles SR, Wilson TM, Berman D, Mathur AK. Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients. Abstract: Background: Pregnancy after solid organ transplant is a significant priority for transplant recipients but how patients report being counseled is unknown. Methods: We performed a single-center retrospective cohort study and telephone survey of female patients ages 18–49 at the time of kidney, pancreas, or liver transplant from 2000 to 2012 (n = 532). Data on pregnancy counseling, fertility, and maternal, fetal- and transplant- specific outcomes were collected. Multivariate Cox models assessed the impact of pregnancy on graft-specific outcomes. Results: The survey response rate was 29% (n = 152). One-third (n = 51) of women were actively counseled against pregnancy by one or more providers. A total of 17 pregnancies occurred among nine patients (5.9%), with 47% live births, 47% early embryonic demises, 5.9% stillbirths. Of live births, 50% were premature. Gestational complications, including diabetes, hypertension, and preeclampsia were present in 88% of mothers. Pregnancy after transplant was associated with higher rates of acute rejection than nulliparous transplant recipients (33% vs. 5.6%, p = 0.07) but did not significantly affect graft survival (HR = 1.00, 95% CI 0.99–1.01), after stratifying by organ and adjusting for clinical factors. Conclusion: This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long-term graft function. Devon M. Rupley a , Allison M. Janda a , Steven R. Kapeles a , Tim M. Wilson a , Deborah Berman b and Amit K. Mathur c a Section of Transplantation Surgery, Department of Surgery, University of Michigan, b Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI and c Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA Key words: abdominal organ – acute rejection after pregnancy – fertility in transplant patients – fetal outcomes – graft failure after pregnancy – preconception counseling – pregnancy after transplant – pregnancy outcomes – prenatal counseling – transplant Corresponding author: Amit K. Mathur, MD, MS, Division of Transplant Surgery, Department of Surgery, Mayo Clinic, 5777 East Mayo Blvd., Phoenix, AZ 85054, USA. e-mail: mathur.amit@mayo.edu Conflict of interest: None. Accepted for publication 18 May 2014 As the size of the reproductive-aged transplant population continues to grow, expectations regarding the feasibility, safety, and advisability of pregnancy in solid organ recipients have chan- ged substantially. Since 1958, over 14 000 births have been reported worldwide in transplant recip- ients of solid organs (1). Despite the increasing prevalence of pregnancy in this population, extensive gaps in understanding of the risks to the graft, the organ recipient, and the fetus exist among patients and their providers. These gaps deter effective counseling regarding fertility, pregnancy, and the implications of these events on graft function after solid organ transplant. Currently, counseling patients about pregnancy after transplant is hampered by the lack of high- quality clinical data. Registries of pregnancy out- comes in solid organ transplant recipients have shown that pregnancy is feasible with a higher ges- tational complication rate compared to normal controls, and without a demonstrable effect on long-term graft function (1, 2). However, these data are not systematically collected and are voluntarily provided by patients and centers (3). These studies have been criticized for inflating live birthrates reported in the post-transplant population by almost 10% over normal controls (4–7). Further information regarding the consequences of 937 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Clin Transplant 2014: 28: 937–945 DOI: 10.1111/ctr.12393 Clinical Transplantation